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PubMedDate not supplied

Performance on cognitive tasks in predicting the behavioral competences in the institutionalized elderly.

The questions under consideration concern quantitative and qualitative aspects of the relationship between cognitive abilities and behavioral competences in the elderly institution residents. The former was assessed by an array of five cognitive measures, namely, two Piagetian tasks, Set Test, WAIS Vocabulary and Digit Span subtests and the WMS Associative Learning subtest and the latter by the Stockton Geriatric Rating Scale (SGRS). The overall variance in common between the two sets of variables was approximately 70 percent. Of the cognitive tasks, those most highly predictive of behavioral competences were the Piagetian tasks, Set Test and, to a lesser extent, WAIS Vocabulary subtest. Of the four SGRS factors, that predicted to the greatest extent was apathy, with physical disability to a lesser extent.

Aged↗
PubMed1992

Institutionalized elderly women have lower food intake than do those living more independently (Dutch Nutrition Surveillance System).

The habitual intake of energy and nutrients (assessed through dietary history) among elderly women (aged 65 and over) living in a nursing home (n = 54), elderly women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and elderly women living independently (n = 52) was evaluated within the framework of the Dutch Nutrition Surveillance System. Intake of energy and nutrients was lowest among women in the nursing home and highest among those living independently. Almost all differences in absolute intake found were significant, both unadjusted and adjusted for age. In the nursing home the intake of energy and nutrients was lower at higher age. In qualitative terms the differences among the groups of women were less striking. Mean daily intakes of iron, vitamin A, thiamin, vitamin B6 and vitamin C were below the Dutch recommended dietary allowances (RDAs) among the nursing home women. Several interrelationships among nutrient intakes were found, low intake levels clustering somewhat among elderly subjects. Our data indicate that these nutritional risks are due to a lower food intake resulting in a lower intake of energy and nutrients, and owing to differences in food choice resulting in a lower nutrient density. We conclude that it is difficult to design a diet containing all essential nutrients at the RDA level in a nursing home with residents who have a relatively low intake of energy, especially among those at higher age.

Aged↗
PubMed1992

Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System).

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.

Aged↗
PubMedDate not supplied

Institutionalizing women's oppression: the inherent risk in health policy that fosters community participation.

Current Canadian health policy is based on the implicit assumption that women are available to provide care in the home to the dependent, the ill, the elderly, and the physically and mentally disabled. Women are socialized from birth to accept caring roles within a traditional family structure, and current societal expectations and social policy reinforce this value system. Women's health can only be understood within the context of their lived experience of social inequity, medicalization, and family caregiving. Health care professionals are complicit in sustaining women's oppression by reinforcing these institutions of social control. For health policy to be responsive to women's needs, it must be based on research that considers the social complexity of ordinary women's lives.

Canada↗
PubMed2003

Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data.

PURPOSE: In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. METHODS: We analysed data from a prospective follow-up study in The Netherlands (n = 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. RESULTS: Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. CONCLUSIONS: It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.

Activities of Daily Living↗
PubMed2004

Institutionalizing interdisciplinary health professions programs in higher education: the implications of one story and two laws.

The interdisciplinary education of health professionals in the USA has increasingly been tied to renewed efforts directed toward quality improvement in the healthcare system, where problems with communication, collaboration, and cooperation are seen as endemic. Many of the published reports and recommendations on interdisciplinary programming, however, have omitted or downplayed the difficulties and challenges of developing and sustaining efforts in this area. Through the presentation of a detailed case study and the exploration of two laws of interdisciplinary programming proposed from it, this paper explores the fundamental difficulties of developing and, more importantly, sustaining interdisciplinary health professions programs in higher educational settings. The utilization of strategies based on emerging forces in the healthcare system and in higher education itself is suggested for initiating interdisciplinary projects, and structural and procedural factors are explored as critical in guaranteeing the long-term sustainability of such programs. Recommendations for the successful development and implementation of interdisciplinary programs in higher educational contexts are suggested, focusing particularly on the role of an advocate in the top down and bottom up development and maintenance of the resources needed for the success of such programs.

Curriculum↗
PubMed1977

When to institutionalize the elderly.

Comprehensive evaluation and follow-up of the chronically ill aged patient may show that he can stay at home with support from family and community services. Guidelines are given for choosing a nursing home when necessary.

Aged↗
PubMed1990

Influenza outbreaks in nursing homes: how effective is influenza vaccine in the institutionalized elderly?

During the 1984-1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p less than .05); only three (14%) vaccinated residents had HI titers of greater than or equal to 40. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.

Adult↗
PubMed1985

Use of environmental manipulation and classroom and modified informal reality orientation with institutionalized, confused elderly patients.

The effectiveness of 'classroom' reality orientation (CRO) for confused elderly subjects was evaluated. Experimental groups 1 and 2 (each consisting of five subjects) received CRO for 1 month with only group 1 continuing with maintenance CRO for a further 2 months. Both experimental groups and the control group (10 subjects) received modified informal reality orientation (IRO) and environmental manipulation (EM) for all 3 months. All subjects were assessed prior to the start of the study and after 4 and 12 weeks of treatment on cognitive and behavioural measures. Both experimental groups showed significant improvement on both cognitive and behavioural measures after 1 month compared with the controls. This improvement was maintained at 12 weeks for both experimental groups but there was a statistically significant difference only between group 1 and its matched controls.

Aged↗
PubMed1986

Significance of pharyngeal colonization with aerobic gram-negative bacilli in elderly institutionalized men.

The prevalence of pharyngeal colonization with aerobic Gram-negative rods was studied on three occasions during one year in 68 elderly males resident on two long-term care wards. For the three surveys, pharyngeal carriage was identified in 43%, 43%, and 37% of residents. Each resident tended to remain either colonized or noncolonized. Pharyngeal colonization was associated with resident incontinence, the development of infection, and increased mortality during the year of observation.

Aerobiosis↗
PubMed1987

Low serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in institutionalized old people: influence of solar exposure and vitamin D supplementation.

The vitamin D status was investigated in 94 geriatric patients in a Danish long-stay ward. The influence of mobility and thus possibility of outdoor activity was studied as well as the influence of regular vitamin D intake. Serum levels of 25-hydroxyvitamin D (25-OHD) were significantly reduced in all groups compared with age-matched controls. In 50% of the patients hypocalcaemia and elevated levels of alkaline phosphatase and immunoreactive parathyroid hormone (iPTH) were found in combination with severely reduced serum 25-OHD values (less than 5 ng/ml) indicating the presence of osteomalacia. Supplementation with 400 IU vitamin D daily in the winter months resulted in significantly higher 25-OHD levels and normocalcaemia while slightly elevated levels of alkaline phosphatase and iPTH persisted. The serum concentrations of 25-OHD were highest in the subjects who were not confined to bed. In these patients the biochemical parameters reflecting osteomalacia were normal. Low serum 1,25-dihydroxyvitamin D levels were found in the patients with low 25-OHD while 24,25-dihydroxyvitamin D levels were within the normal range in all groups and correlated with 25-OHD. Daily vitamin D supplementation appears to be indicated for geriatric patients, especially when bedridden, even in countries where the nutritional vitamin D intake is high.

Aged↗
PubMed1988

A study of zinc status of elderly institutionalized patients.

In a study of zinc status in the elderly, the mean serum and leucocyte zinc concentrations were found to be significantly lower in continuing-care patients compared with elderly people living in the community. The mean daily dietary intakes of zinc, protein and fibre did not differ between the two groups. Serum zinc levels were found to correlate with serum albumin levels. No significant relationship was found between the mean serum or leucocyte zinc concentrations of patients and either their mental status or the presence of skin pressure damage, leg ulcers or unhealed wounds.

Aged↗
PubMed1992

Is relocation harmful to institutionalized elderly people?

One hundred and one elderly continuing-care residents were relocated, from a hospital which closed, to new or refurbished accommodation at another hospital. Barthel and CAPE scores were used to assess changes in disability. Small improvements in disability over the relocation period were seen compared with changes seen over a subsequent, 2-month control period. The monthly mortality rate in the 6 months after relocation was not statistically different from that in the corresponding 6 months the previous year. Relocation to more appropriate accommodation may have had overall beneficial effects on disability.

Activities of Daily Living↗
PubMed1992

Use of drugs by non-institutionalized urban Finns born in 1904-1923 and the association of drug use with mood and self-rated health.

The purpose of this study was to examine the use of drugs by elderly people and to investigate its associations with various other factors. Random sampling was used to select 800 interviewees born in 1904-13 and a further 800 born in 1914-23. The average number of prescribed drugs per person was 2.2. Women used a greater number of prescribed drugs than did men; and this difference increased with age. The use of vitamins and trace elements seemed to decline with increasing age. Among women a significant association between the use of prescribed drugs and depressive symptoms was found. Women in the older age group used prescribed drugs more often than women in the younger age group. One fifth of the subjects had a greater number of drugs in simultaneous use than is generally recommended. It seems that, especially among elderly women, depression often remains undiagnosed and treatments are chiefly provided for the associated symptoms.

Activities of Daily Living↗